الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility, characterized by chronic anovulation and hyperandrogenism. Frequently encountered endocrine features are hypersecretion of LH, hyperandrogenemia and compensatory hyperinsulinemia. In vitro fertilization is an effective treatment after repeated failure of ovulation induction by clomiphene citrate and gonadotrophin.
Ovarian stimulation has become a key component of assisted reproductive technologies (ART). For 25 years, ovarian stimulation has been applied with the aim of increasing the number of oocytes in order to compensate for inefficiencies of the in vitro fertilization procedure enabling the selection of one or more embryos for transfer. Currently used medication regimens for ovarian stimulation are complex, expensive, may require weeks of daily injections and intense ovarian response monitoring is usually needed. Such regimens are associated with the risk of complications such as ovarian hyperstimulation syndrome (OHSS).
Aromatase inhibitors (Letrozole) selectively inhibit the conversion of androgens to estrogens in granulosa cells of developing ovarian follicles, resulting in a subsequent increase in intra-ovarian androgens and absence of a rise in estrogens.
Due to a reduced estrogen feedback and resulting increased endogenous gonadotrophin secretion, the need for exogenous gonadotrophins is likely to be reduced when aromatase inhibitors are administered in the early follicular phase. Aromatase inhibitors may therefore serve a similar purpose as Clomiphene Citrate.
Like Clomiphene Citrate, aromatase inhibitors are orally taken and are cheap. However, compared with Clomiphene Citrate they offer the potential advantage of not causing depletion of estrogen receptors.
Tamoxifen (Nolvadex) is a non steroidal triphenylethylene antiestrogen is used as an ovulation induction agent in Europe. When used as an ovulation induction agent, tamoxifen was typically administered at 20 to 60 mg for 5 days.
The aim of the work was to compare between two minimal stimulation protocols: Letrozole with minimal step up gonadotrophins stimulation protocol versus Nolvadex with minimal step up gonadotrophins stimulation protocol in PCOS women undergoing ICSI.
This study was a randomized prospective study which conducted on 20 patients with PCOS undergoing ICSI cycles admitted to El-Shatby Maternal Hospital.
Patients was randomized by computer-generated list to receive either Letrozole with minimal dose of gonadotropins with step up protocol or Nolvadex with minimal dose of gonadotropins with step up protocol.
Every patient